Provider Demographics
NPI:1295289015
Name:WALMART PHARMACY
Entity type:Organization
Organization Name:WALMART PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:847-378-1052
Mailing Address - Street 1:727 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2414
Mailing Address - Country:US
Mailing Address - Phone:847-378-1052
Mailing Address - Fax:847-378-0993
Practice Address - Street 1:727 W GOLF RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-2414
Practice Address - Country:US
Practice Address - Phone:847-378-1052
Practice Address - Fax:847-378-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049032218261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health